US10983071B2 - Pulse-width modulation for a photon scanning apparatus - Google Patents

Pulse-width modulation for a photon scanning apparatus Download PDF

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US10983071B2
US10983071B2 US16/305,446 US201816305446A US10983071B2 US 10983071 B2 US10983071 B2 US 10983071B2 US 201816305446 A US201816305446 A US 201816305446A US 10983071 B2 US10983071 B2 US 10983071B2
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photon
detector
pulse width
photons
source
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US20200319121A1 (en
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Heiner Daerr
Roland Proksa
Frank Bergner
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Koninklijke Philips NV
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    • G—PHYSICS
    • G01—MEASURING; TESTING
    • G01T—MEASUREMENT OF NUCLEAR OR X-RADIATION
    • G01T1/00—Measuring X-radiation, gamma radiation, corpuscular radiation, or cosmic radiation
    • G01T1/16—Measuring radiation intensity
    • G—PHYSICS
    • G01—MEASURING; TESTING
    • G01N—INVESTIGATING OR ANALYSING MATERIALS BY DETERMINING THEIR CHEMICAL OR PHYSICAL PROPERTIES
    • G01N23/00—Investigating or analysing materials by the use of wave or particle radiation, e.g. X-rays or neutrons, not covered by groups G01N3/00 – G01N17/00, G01N21/00 or G01N22/00
    • G01N23/02—Investigating or analysing materials by the use of wave or particle radiation, e.g. X-rays or neutrons, not covered by groups G01N3/00 – G01N17/00, G01N21/00 or G01N22/00 by transmitting the radiation through the material
    • G01N23/04—Investigating or analysing materials by the use of wave or particle radiation, e.g. X-rays or neutrons, not covered by groups G01N3/00 – G01N17/00, G01N21/00 or G01N22/00 by transmitting the radiation through the material and forming images of the material
    • G01N23/046—Investigating or analysing materials by the use of wave or particle radiation, e.g. X-rays or neutrons, not covered by groups G01N3/00 – G01N17/00, G01N21/00 or G01N22/00 by transmitting the radiation through the material and forming images of the material using tomography, e.g. computed tomography [CT]
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment
    • A61B6/02—Arrangements for diagnosis sequentially in different planes; Stereoscopic radiation diagnosis
    • A61B6/03—Computed tomography [CT]
    • A61B6/032—Transmission computed tomography [CT]
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment
    • A61B6/42—Arrangements for detecting radiation specially adapted for radiation diagnosis
    • A61B6/4208—Arrangements for detecting radiation specially adapted for radiation diagnosis characterised by using a particular type of detector
    • A61B6/4241—Arrangements for detecting radiation specially adapted for radiation diagnosis characterised by using a particular type of detector using energy resolving detectors, e.g. photon counting
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment
    • A61B6/54—Control of apparatus or devices for radiation diagnosis
    • A61B6/542—Control of apparatus or devices for radiation diagnosis involving control of exposure
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment
    • A61B6/58—Testing, adjusting or calibrating thereof
    • A61B6/582—Calibration
    • G—PHYSICS
    • G01—MEASURING; TESTING
    • G01T—MEASUREMENT OF NUCLEAR OR X-RADIATION
    • G01T1/00—Measuring X-radiation, gamma radiation, corpuscular radiation, or cosmic radiation
    • G01T1/02—Dosimeters
    • G—PHYSICS
    • G01—MEASURING; TESTING
    • G01T—MEASUREMENT OF NUCLEAR OR X-RADIATION
    • G01T7/00—Details of radiation-measuring instruments
    • G01T7/005—Details of radiation-measuring instruments calibration techniques

Definitions

  • the present invention generally relates to photon scanning apparatuses and methods for operating the same and more particularly to calibrating photon-counting imaging detectors described with particular application to spectral computed tomography (CT).
  • CT spectral computed tomography
  • a conventional CT scanner includes an X-ray tube mounted on a rotatable gantry opposite a detector array located across an examination region.
  • the rotatable gantry, and hence the X-ray tube rotates around the examination region.
  • the X-ray tube is configured to emit X-ray radiation.
  • a radiation intensity profile shaper such as the well-known “bow-tie” filter attenuates the emitted X-ray radiation directed towards the examination region to a greater degree at peripheral regions, relative to a more central region, thereby reducing the flux at the outer regions, which improves radiation efficiency.
  • a source collimator collimates the filtered X-ray radiation, producing a radiation beam in the direction of the examination region.
  • the filtered radiation beam traverses the examination region (and an object of interest therein), and is detected by a detector array, which includes a one or two dimensional array of detector pixels.
  • the detector pixels in response, generate and output signals indicative of the detected radiation.
  • the signal can be reconstructed to generate volumetric image data. Additionally, the volumetric image data can be processed to generate one or more images of the object of interest.
  • a spectral CT scanner has included the above-discussed elements with the addition of photon-counting detector pixels (sensor material e.g., CdTe, CdZnTe, etc.) (and, optionally multiple sources, kVp switching, etc.).
  • sensor material e.g., CdTe, CdZnTe, etc.
  • the bow-tie filter alters the primary beam spectrum of the X-ray source. That is, while the spectrum in front of the bow-tie filter can be considered homogenous for all angles, spectral distortions are caused by the bow-tie filter material, and the shape of the bow-tie filter results in variations in fan angle direction.
  • One common approach of calibrating photon counting detectors is to map a known set of absorber compositions to detector signals, which are subsequently used, e.g. in form of a look-up table, for material decomposition.
  • This technique thus requires a calibration phantom whose complexity increases with number of absorber materials, since each material combination that may occur in measured objects has to be realized in the calibration procedure or an equivalent pair of absorbers as described in “Estimator for photon counting energy selective x-ray imaging with multibin pulse height analysis” by Alvarez, Robert E., Med. Phys. 38 (5), pages 2324-2334, May 2011.
  • a calibration procedure has to be performed, where all combinations of all relevant thicknesses of bone, e.g., 0-10 cm, and all relevant thicknesses of soft tissue, e.g., 0-40 cm, have to be taken into account.
  • a suitable procedure would be to produce two step phantoms of materials with similar X-ray attenuation properties as bone and soft tissue, e.g., aluminum and a polymer, respectively, and acquire data for all combinations of step numbers of both step phantoms.
  • the calibration data has to be acquired for all detector pixels. For example, a step phantom comprising 10 material thicknesses each, a total of 100 individual measurements would have to be made for each pixel. With a third material, e.g., iodine or another contrast agent, a third material would have to be included, adding an additional dimension to the calibration procedure.
  • a third material e.g., iodine or another contrast agent
  • Another approach comprises a detector model to estimate the photon counts for each material combination.
  • the detector model needs to be calibrated using a calibration phantom with one or more materials.
  • each detector pixel needs to be calibrated due to pixel-to-pixel variation within the detector and changes of the primary spectrum due to the bow-tie already mentioned above.
  • the described calibration is necessary not only for different material combinations, but also for different combinations of X-ray tube currents and X-ray tube acceleration voltages due to the effect of pulse pile-up.
  • Advanced CT scanners use dynamic dose modulation to adapt the X-ray flux for each projection according to the attenuation profile of a patient.
  • Dose modulation is an indispensable feature in medical imaging as it adopts the X-ray flux to the patient's anatomy. Dose modulation may be achieved by modulating the X-ray tube current. Accordingly, the working point of the detector would vary from view to view, which would require a proper calibration for all occurring working point settings of the scanner during the scan, since the detected counts are a non-linear function of the incoming photon flux.
  • GS X-ray tube grid switching
  • the flux modulation can be used to do sparse angular sampling for CT.
  • it enables a kind of pulse width modulation to radiate the detector only for a limited time interval within an integration period, thus allowing to expose a patient to X-ray radiation as little as necessary.
  • US patent application US 2016/0324494 A1 discloses an imaging system which includes a radiation source with a focal spot that emits a beam of X-ray photons that traverses an examination region.
  • the imaging system further includes a photon counting detector array that detects a sub-set of the X-ray photons that traverse an examination region.
  • the imaging system further includes a controller that generates and transmits a pause signal, in response to a calculated drop in an intensity of the emitted the beam of X-ray photons below a predetermined intensity level, which causes the photon counting detector array to pause detecting the sub-set of the X-ray photons.
  • the imaging system further includes a counter that counts, for each of a plurality of counting periods, the X-ray photons of the sub-set detected by the photon counting detector array in the corresponding counting period.
  • US patent application US 2005/0089135 A1 discloses a system and method of diagnostic imaging is provided that includes determining a position of a subject in a scanning bay and tailoring X-ray attenuation such that the specific position of the subject is taken into consideration.
  • a proper attenuation filter configuration is automatically selected, patient centering is corrected and noise prediction errors are corrected, thereby increasing dose efficiency and tube output.
  • a photon scanning apparatus comprising a photon source to emit a photon beam, a photon detector positioned in the propagation direction of the photon beam to detect photons emitted from the photon source, wherein the photon source and the photon detector are commonly rotatable around a central axis, wherein the photon source is adapted to emit the photon beam in accordance with a predetermined pulse width modulation scheme at a predetermined flux rate, wherein the pulse width modulation scheme defines pulse widths of the photon beam for respective positions of the photon source and the photon detector around and along the central axis and an object to be scanned, and wherein the photon detector is adapted to start detecting photons for a time period corresponding to the predetermined pulse width with a delay relative to the photon source starting to emit photons and to finish detecting photons prior to the photon source stopping to emit photons.
  • the photon detector can be operated at a single flux rate.
  • the detector only needs to be calibrated for the predetermined flux rate which significantly reduces the calibration effort required for conventional flux modulation.
  • the photon scanning apparatus may preferentially be a spectral CT scanner.
  • the photon source and photon detector may be parts of a gantry which is adapted to rotate around a central axis.
  • the gantry may also be movable in a direction along the central rotation axis to allow a helical movement along the central axis.
  • the gantry may only be rotatable around the central axis, and support means positioned along the central axis can be moved with respect to the gantry along the rotational axis. Both arrangements allow scans of a patient positioned at the central axis in a helical manner.
  • the photon source is adapted to emit a photon beam, preferentially a polychromatic photon beam, in accordance with a predetermined pulse width modulation scheme.
  • Pulse width modulation schemes can be realized via so called grid-switching mechanisms as described in “Grid controlled x-ray tube switching time: Implications for rapid exposure control” by Plewes, D. B. and Vogelstein, E., Med. Phys. 11 (5), pages 693-696, September/October 1984.
  • the pulse width modulation scheme is patient specifically determined for respective positions of the photon source and detector arrangement, e.g. positions of the gantry, and depends on the region of interest to be scanned, e.g. the anatomical region or organ to be examined.
  • the photon scanning apparatus may comprise a memory storing a look-up table, wherein the look-up table associates photon beam pulse widths for respective regions of interest and patient conditions with respective positions of the photon source, e.g. the gantry.
  • the look-up table associates photon beam pulse widths for respective regions of interest and patient conditions with respective positions of the photon source, e.g. the gantry.
  • CT scout scan or scanogram the position of the region of interest is determined.
  • the same region of interest for example the same organ, may still require a different dosage depending on the patient conditions, e.g. body type (obesity, age, heath, etc.) and the resolution required for a diagnosis.
  • the respective input may be provided by a user of the photon scanning apparatus.
  • the photon source is adapted to emit a photon pulse of the respective duration.
  • the photon detector is adapted to start detecting photons with a delay relative to the photon source starting to emit photons. The delay is chosen such that the photon detector starts counting photons when the photon flux is stable. Pile up effects occurring for the stable flux rate are accounted for in the reconstruction, e.g. the photon counting detector is calibrated for this working point. The pile up effects occurring during rise up and ramp down of the flux are different and can therefore not be accounting for during reconstruction. During rise up and ramp down of the photon flux the pile up effect might cause the detector response to allegedly count more photons than actually incoming.
  • the delay time may be determined in advance either during manufacturing or during calibration.
  • the photon detector is further adapted to finish detecting photons prior to the photon source stopping to emit photons.
  • the photon detector may stop counting photons simultaneously with the photon source receiving a command to finish photon emission. Upon receipt of this command the photon flux will be ramped down. By stopping the photon counting at the same time as the photon flux is ramped down, it is ensured that no pile up effects influence the photon counts.
  • the photon scanning apparatus can exploit pulse width modulation and thus only requires a single calibration or least only calibrations for a few working points which decreases the calibration effort significantly compared to conventional dose modulation schemes.
  • the photon source is adapted to issue a command indicative of an emission period corresponding to a predetermined pulse width to the photon detector upon starting to emit the photon beam, and the photon detector is adapted to start counting photons upon a predetermined delay after receipt of the command until the end of the emission period.
  • the photon flux is not immediately set to zero but is ramping down.
  • pulse pile up effects occur such that the photon detector is adapted to stop counting photons with the end of the regular emission period and thus before the flux is decreased.
  • the photon source is adapted to issue a command indicative of an emission time corresponding to a predetermined pulse width to the photon detector with a predetermined delay after having started to emit photons, and the photon detector is adapted to start counting photons upon receipt of the command for a time period that is shorter than the predetermined pulse width by a predetermined amount.
  • the initial delay is controlled by the photon source. This may be in particular advantageous if the rise time differs and is sensed and estimated by the photon source based on the slope of the rise curve until the nominal flux rate is reached.
  • the photon source may additionally correct the nominal pulse width for the determined delay and send this corrected pulse width to the photon detector, which then simply switches on after receipt of the command and off after the time period corresponding to the corrected pulse width has passed.
  • the logic on the other side may be simpler, in this case the logic at the photon detector side.
  • the logic to correct the time period corresponding to the corrected pulse width may also be implemented at the photon detector side. In both cases, the photon detector stops photon counting before the photon flux is ramped down.
  • the photon scanning apparatus further comprises a control unit to determine a rotational position of the photon source and photon detector in accordance with the pulse width modulation scheme and to issue control commands to the photon source and the photon detector indicative of respective operation periods corresponding to a particular pulse width
  • the photon source is adapted to start emitting photons upon receipt of the control command for an emission period corresponding to the particular pulse width
  • the photon detector is adapted to start counting photons upon a predetermined delay after receipt of the control command for a detection period that ends with the emission period.
  • the control unit may issue simultaneously control commands to the photon source and to the photon detector indicative of respective operation periods corresponding to a particular pulse width.
  • the logic to determine the delay and the shortened detection period that ends together with the emission period to avoid counting photons while the photon flux is ramped down may again be comprised at the photon detector side to avoid the need of calculating the delay at both sides.
  • the logic may also be distributed at the control unit and the photon detector such that the control unit already provides a command indicating a detection period that ends with the emission period.
  • the photon scanning apparatus further comprises a control unit to determine a rotational position of the photon source in accordance with the pulse width modulation scheme and to issue a first control command to the photon source, wherein the photon source is adapted to start emitting the photon beam upon receipt of the first control command for a predetermined first period of time, and to issue a second control command to the photon detector wherein the photon detector is adapted to start counting photons upon receipt of the second control command for a predetermined second period of time that ends with the first period of time.
  • the trigger logic at the photon source and the photon detector is kept as simple as possible. Upon receipt of respective commands the photon source and the photon detector start operation. With regard to the determination of the second period of time, the respective logic may again be provided at the control unit or at the photon detector side.
  • a method for operating a photon scanning apparatus at a predetermined flux rate comprising a photon source to emit a photon beam according to a predetermined pulse width modulation scheme and a photon detector positioned in the propagation direction of the photon beam to detect photons emitted from the photon source, wherein the photon source and the photon detector are commonly rotatable around a central axis, are presented.
  • the method comprises scanning the object using a pulse width according to the pulse width modulation, wherein the photon detector starts detecting photons for a time period corresponding to the predetermined pulse width with a predetermined delay relative to the photon source starting to emit photons, and wherein the photon detector finishes detecting photons prior to the photon source stopping to emit photons.
  • photon scanning apparatus of claim 1 the method for operating a photon scanning apparatus of claim 7 and the computer program of claim 8 have similar and/or identical preferred embodiments, in particular, as defined in the dependent claims.
  • FIG. 1 schematically and exemplarily shows a photon scanning apparatus according to an embodiment of the present invention
  • FIG. 2 schematically and exemplarily shows a nominal integration period of a photon detector and the photon flux and photon counts for a photon pulse;
  • FIG. 3 schematically and exemplarily shows a typical response curve for a photon counting detector affected by pile-up compared to a response curve for an ideal photon counting detector without pulse pile-up.
  • FIG. 1 shows an embodiment of a photon scanning apparatus according to the present invention, in particular a spectral CT imaging system for medical applications and examination of a patient.
  • the CT imaging system shown in FIG. 1 includes a gantry 1 which is capable of rotation about an axis of rotation R which extends parallel to the z direction.
  • the radiation source 2 in particular a conventional X-ray tube, for instance with rotating tungsten anode is mounted on the gantry 1 .
  • the X-ray tube 2 is provided with a collimator device 3 which forms a shaped radiation beam 4 , such as a fan, cone wedge or any other pre-determined shape, from the radiation produced by the X-ray tube 2 .
  • the radiation traverses an object (not shown), such as a patient positioned on a support 5 , in a region of interest in a cylindrical examination zone (imaging region).
  • an X-ray detector unit 6 in this embodiment a two-dimensional photon-counting detector having a plurality of detector cells 61 , which is mounted on the gantry 1 and which converts incident X-ray radiation into detection signals.
  • the gantry 1 is driven at a preferably constant but adjustable angular speed by a motor 7 .
  • a further motor 8 is provided for displacing the object, e.g. the patient who is arranged on a patient table in the examination zone 5 , parallel to the direction of the axis of rotation R or the z axis as indicted in FIG. 1 .
  • These motors 7 , 8 are controlled by a control device 9 , for instance such that the radiation source 2 and the examination zone 5 move relative to one another along a helical trajectory.
  • the object or the examination zone 5 is not moved, but that only the X-ray source 2 is rotated.
  • a source control device 10 For controlling the X-ray source 2 , in particular for modulating the X-ray flux that is provided by said X-ray source 2 , a source control device 10 is provided.
  • This source control device 10 ensures that the X-ray flux emitted by the X-ray source 2 is provided at a pre-determined flux level for a predetermined duration or pulse width.
  • the pulse width can be realized using a grid switching arrangement at the photon source.
  • WO 2010/058330 A1 is shown in FIG. 2 of WO 2010/058330 A1 which is incorporated herein by reference in its entirety. Wherein WO 2010/058330 A1 discloses to use the grid switching mechanism to block the electron beam in case of the detection of any damaging effect, the grid may also be used to modulate the pulse widths.
  • the X-ray source 2 and photon detector 6 are preferably calibrated for a predetermined number of working points, for instance five working points. Wherein in principle a single working point, e.g. one current per acceleration voltage, would be sufficient since the dose will be modulated by the exposure time, e.g. the pulse width, it may be appropriate to define more than one working point to avoid very large exposure times for objects with high absorption characteristics or very short integration time and high amount of pulse pile-up for low absorbing objects. For instance, in order to obtain spectral CT images from regions in the extremities only a low dose is needed, such that a short pulse width and/or a low flux rate are sufficient.
  • the anatomical region of the stomach on the other hand requires a much higher dose in order to obtain an image with acceptable noise.
  • the pulse width would be much higher. Longer exposure times prolong the procedure as a whole which is undesirable in itself.
  • a patient may slightly move during exposure, e.g. when breathing in or out, which may lead to a decrease in the precision of the reconstructed image.
  • it may be advantageous to have three to five working point of the X-ray flux for a given X-ray tube acceleration voltage for respective regions with significantly differing absorption characteristics.
  • a patient specific pulse width modulation scheme is determined, defining respective positions of the X-ray tube 2 and thus also of the photon counting detector 6 on the opposite side of the gantry 1 and corresponding exposure times or pulse widths for each position.
  • the pulse widths may be determined from a look-up table defining pulse widths for respective gantry positions and imaging subjects, such as specific organs, etc., as well as patient specific parameters like age, size/volume, etc. and absorption characteristics determined during the scout scan.
  • the control device 9 When performing the actual scan, the control device 9 provides respective commands to the motors 7 and 8 to position the support 5 and rotate the gantry 1 around the examination zone. For predetermined positions, the control device 9 issues operation commands to the source control device 10 that initiate the corresponding emission of a radiation beam 4 by the X-ray source 2 for a time period corresponding to the predetermined pulse width. The control device 9 simultaneously issues respective commands to a detector control device 11 that initiates operation of the photon detector 6 with a predetermined delay, e.g. 1-3 ⁇ sec, compared to the initiation of the X-ray source 2 . Furthermore, the detector control device 11 stops operation of the photon detector 6 after the time period corresponding to the predetermined pulse width has been reached, e.g.
  • the detector 6 stops operation together with or even slightly before the X-ray source 2 .
  • the photons arriving at the detector during the time required for the X-ray source 2 upon receipt of a start or stop command until the current that controls the photon emission is ramped up or down, are thus not counted by the photon detector 6 as indicated in FIG. 2 .
  • the curve 102 shows the photon flux
  • the curve 103 shows the photons counted by the detector.
  • the gantry 1 rotates with a speed that provides a certain nominal integration period 100 , e.g. 400 ⁇ sec for each position.
  • the pulses emitted from the X-ray source 2 may be much shorter than the nominal integration period 100 , e.g. 200 ⁇ sec.
  • the detector's photon counting rate firstly rises linearly but then falls off due to pile up.
  • FIG. 3 shows exemplarily a typical pulse pile-up curve for an ideal photon counting detector I and for a real photon counting detector II.
  • the x-axis shows the input rate, the y-axis the output rate.
  • the axes are normalized to the dead time of the detector T.
  • An ideal photon counting detector would have identical input and output rates.
  • a real photon detector starts with a linear response and encounters counting losses with increasing input rates. For very high rates, the detector saturates and the output rate decreases (behind the input rate times ⁇ equals 1). For a stable flux, the counting losses due to pile up can be accounted for, e.g. the detector is calibrated for this working point and the calibration is taken into account during image reconstruction. However, the detector response during rise up and ramp down times would significantly impact the overall counting rate. These miscounts cannot be easily corrected for in the image reconstruction. Therefore, the actual integration period 101 of the photon detectors 6 starts with a delay relative to the start of the X-ray source ON period and stops before the photon flux is ramped down as shown in FIG. 2 .
  • respective hardware triggers may be programmed with the determined delay time such that whenever a start command and a corresponding pulse width is received from the device control unit 9 , the detector control device 11 will trigger the detector's operation with the programmed delay and stop the detector's operation with the end of the nominal pulse width.
  • the logic to delay the trigger command may also be implemented in the control unit 9 instead of the detector control device 11 .
  • the detector control device 11 would trigger the operation of the photon detector 6 immediately upon receipt of the respective command from the control unit 9 .
  • the control unit 9 would issue the start command with a slight delay compared to the start command issued to the source control device 10 .
  • the source control device 10 and the detector control device 11 may communicate with one another wherein the source control device 10 issues a respective trigger command to the detector control device 11 when it starts operating the X-ray source 2 for a predetermined pulse width.
  • the detector control device 11 starts operation of the photon detectors 6 with a predetermined delay upon receipt of the command and stops the photon detector 6 when the time corresponding to the nominal pulse width has been reached.
  • the delay logic could also be implemented in the source control device 10 which may alternatively issue the start command to the detector control device 11 with a predetermined delay.
  • control of the photon scanning apparatus in accordance with the method for operating the photon scanning apparatus can be implemented as program code means of a computer program and/or as dedicated hardware.
  • a computer program may be stored/distributed on a suitable medium, such as an optical storage medium or a solid-state medium, supplied together with or as part of other hardware, but may also be distributed in other forms, such as via the Internet or other wired or wireless telecommunication systems.
  • a suitable medium such as an optical storage medium or a solid-state medium, supplied together with or as part of other hardware, but may also be distributed in other forms, such as via the Internet or other wired or wireless telecommunication systems.

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